Neck pain is a leading cause of disability. The incidence of cervical radiculopathy peaks in the fourth and fifth decades of life and has an annual incidence of 83 per 100,000.
The cervical vertebrae begin at the base of the skull and create the skeletal support structure of the neck. There are 7 cervical vertebra (neckbones) and 8 pairs of cervical nerves that branch out from the spinal cord through the vertebrae to supply the muscles in the shoulders, arms, hands, and fingers. Intervertebral discs are pads of cartilage between the vertebrae. They are filled with a jelly – like center that cushion the bones of each pair of vertebrae, and allows for movement and flexibility, holds the vertebrae in place and absorbs shock. C5 through C8 control the muscles in the shoulder, upper arm and lower arm, hand, and wrist.
Radiculopathy is defined as injury or irritation to a nerve root that can cause any combination of the following symptoms: pain, weakness, numbness, and tingling.
Cervical radiculopathy is the medical term for irritation/impingement of any nerve root originating in the neck. It is characterized by neck pain and pain that radiates from the neck into the shoulder and may have associated numbness, tingling and weakness in the arms and fingers. Significant functional limitations and disabilities are common. Cervical radiculopathy can be a disabling condition that has a significant negative impact on the quality of life, mental health, physical function, and social participation. Cervical radiculopathy is common in individuals with degenerative changes in the spine due to aging. 80% of cervical radiculopathy affects C6 or C7 nerve roots.
Aging, heavy lifting, smoking, driving and operating vibrating equipment, trauma to the neck from sports or an auto accident can all be contributing factors in the development of cervical radiculopathy.
The most common cause is inflammation/irritation or damage to a nerve root caused by compression from either cartilage from a disc herniation or bone spurring as a result of more chronic degenerative changes in the cervical spine. Age-related changes in the vertebrae (osteoarthritis) and discs (degenerative disc disease) are often the cause of cervical radiculopathy. Both conditions can put pressure on the cervical nerve roots. Cervical radiculopathy in young people is often due to acute injury that ruptures a disc. Other less common causes include spinal tumors and infections.
As we age the discs naturally degenerate causing tears that allow the jelly- like center to be squeezed out into the spinal canal where it can press against a nerve root. This is called a herniated disc, a bulging disc or ruptured disc. A common cause of a herniated disc is the increased pressure caused by activities such as weightlifting, prolonged coughing, constipation or other activities that involve straining. Herniated discs can also be caused by trauma.
Symptoms of cervical radiculopathy usually affect only one side of the body.
The main symptoms include:
- Sensory problems like numbness and tingling; and motor problems like weakness, abnormal reflexes, and altered coordination.
- Loss of hand dexterity.
- Pain that radiates from the neck into the shoulder, arm, hand, or fingers.
- Sensations like tingling and pins and needles can feel like an electric shock or burning and can also radiate down the arm and into the hand.
- Symptoms may affect only the shoulder or run down the arm into the hands and fingers.
- When severe they can impair the ability to perform functions like gripping and lifting objects, writing, typing, and dressing.
Your Dallas Neurosurgical & Spine expert will ask about your symptoms, review your medical history, and conduct a thorough physical exam including checking range of motion, strength, sensation and reflexes, and other special testing. A functional assessment will evaluate how your pain affects your ability to perform everyday activities. They will also order imaging studies including x-rays to check the bones, CT scans for a detailed view of the cervical spine and an MRI, the gold standard diagnostic test for the cervical spine.
Treatment for cervical radiculopathy is typically conservative initially but in severe or refractory cases surgery may be necessary.